Endometriozis tanısında minimal invaziv bir yöntem olarak endometrial biyopsi örneklerinde sinir liflerinin varlığının araştırılması
Özet
Diagnosis of endometriosis still depends on surgery. Currently, there is no non-invasive diagnostic method and this results in delayed diagnoses. In this study we aimed to evaluate the efficacy and accuracy of detecting presence and types of nerve fibers in endometrial biopsy samples as a minimal invasive diagnostic method for endometriosis. Materials and methods: This study was conducted on atotal of 40patients. Twenty of them was proved to have endometriosis and 20 patients free from endometriosis. Endometrial samples obtained from these 40 patients were stained with PGP 9.5 with immuno-histo-chemical techniques to evaluate the presence of nerve fibers. Subsequently, nerve fiber types were determined by NF, VIP, NPY and CGRP immuno-reactive stains. Results: Positive staining with PGP 9.5 was found significantly higher in women with endometriosis (p=0,022). Sensitivity and specifity of positive PGP 9.5 staining in comparision to current gold standart diagnositic method laparoscopy, were found %80 and %55 respectively. No significant differences were observed amongst groups' staining patterns in terms of menstural phases at sampling time and operation indications. All patients operated with "infertility" indication were stained positive for PGP 9.5. A high rate of staining was observed amonst women operated with indications of "pain" and "other" within control group (%60). Nerve fibers were found to be un-myelinated, cholinergic and adrenergic fibers consequent to nerve fiber type assesment. Conclusion: Low specifitylimits the value of this method as a diagnostic tool. High sensitivity in women without pain in endometriosis group was remarkable. Patients with other gynecologic disorders associated with pain should be included in studies and more specific immunoreactive agents should be used to assess the types of nerve fibers. Further studies needed to clarify this issue.